Abstract Body: INTRODUCTION: Few studies have examined population-level sleep health relative to salient but less well-studied structural / social / emotional determinants of health.
METHODS: Data were used from the 2002 BRFSS (N=193,225). Sleep duration was typical sleep within a 24-hour period and was categorized as <=4h, 5h, 6h, 7h (reference group), 8h, 9h, and 10+h. Participants were asked how often they experienced stress (mind is "troubled all the time"), emotional support ("the social and emotional support you need"), social isolation ("feel socially isolated from others"), food insecurity ("[did] not last, and you didn’t have money to get more"), employment insecurity ("lost employment or had hours reduced"), housing insecurity ("not able to pay your mortgage, rent or utility bills"), transportation insecurity ("lack of reliable transportation"), use of food stamps, and inability to pay utility bills. Weighted models were adjusted for age, sex, race/ethnicity, education, income, and employment.
RESULTS: The experience of stress "Sometimes," "Usually," or "Always" were associated with a greater likelihood of <=4h, 5h, and 6h ("Always" was associated with 10+h only), and a lower likelihood of 8h and 9h (all p<0.0005). Emotional support "Sometimes," "Rarely" and "Never" were associated with elevated likelihood of <=4h, 5h, and 6h (all p<0.0005). Social isolation "Sometimes," "Usually," and "Always" were associated with an increased likelihood of <=4h, 5h, 6h, and 10+h (all p<0.0005). Food insecurity "Rarely," "Sometimes," "Usually," and "Always" were associated with <4h, 5h, and 6h (all p<0.0005), and 10+h (all p<0.014). Employment insecurity was associated with <=4h, 5, and 6h (all p<0.001). Housing insecurity was associated with <=4, 5, and 6h (all p<0.0005) and 10+h (p=0.003). Transportation insecurity was associated with <=4h, 5h, 6h, and 10+h (all p<0.0005). Food stamps use was associated with <=4h, 5h, and 6h (all p<0.003). Inability to pay bills was associated with <=4h, 5h, and 6h (all p<0.0005) and 10+h (p=0.005). In a forward stepwise model, unique variance was contributed by (in order) social isolation, emotional support, food insecurity, inability to pay bills, transportation insecurity, housing insecurity, and food stamps.
CONCLUSIONS: Structural, social, and emotional determinants of health are strongly related to insufficient sleep. Sleep health may partially mediate adverse health outcomes and should be a target for improving social/emotional health.